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Appl Clin Inform 2012; 03(02): 197-209
DOI: 10.4338/ACI-2012-02-RA-0005
Research Article
Schattauer GmbH

Health Information Exchange and Ambulatory Quality of Care

L.M. Kern
1   Department of Public Health, Weill Cornell Medical College, New York, NY.
2   Department of Medicine, Weill Cornell Medical College, New York, NY.
3   Health Information Technology Evaluation Collaborative, New York, NY.
,
Y. Barrón
1   Department of Public Health, Weill Cornell Medical College, New York, NY.
3   Health Information Technology Evaluation Collaborative, New York, NY.
,
R.V. Dhopeshwarkar
3   Health Information Technology Evaluation Collaborative, New York, NY.
4   Department of Pediatrics, Weill Cornell Medical College, New York, NY.
,
R. Kaushal
1   Department of Public Health, Weill Cornell Medical College, New York, NY.
2   Department of Medicine, Weill Cornell Medical College, New York, NY.
3   Health Information Technology Evaluation Collaborative, New York, NY.
4   Department of Pediatrics, Weill Cornell Medical College, New York, NY.
5   New York-Presbyterian Hospital, New York, NY.
› Author Affiliations
Further Information

Correspondence to:

Lisa M. Kern, MD, MPH
Center for Healthcare Informatics and Policy
Weill Cornell Medical College
425 East 61st Street, New York, NY 10065
Phone: 646–962–9402   
Fax: 646–962–0105   

Publication History

received: 24 February 2012

accepted: 02 May 2012

Publication Date:
16 December 2017 (online)

 
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Summary

Background: Health information exchange is a national priority, but there is limited evidence of its effectiveness.

Objective: We sought to determine the effect of health information exchange on ambulatory quality.

Methods: We conducted a retrospective cohort study over two years of 138 primary care physicians in small group practices in the Hudson Valley region of New York State. All physicians had access to an electronic portal, through which they could view clinical data (such as laboratory and radiology test results) for their patients over time, regardless of the ordering physician. We considered 15 quality measures that were being used by the community for a pay-for-performance program, as well as the subset of 8 measures expected to be affected by the portal. We adjusted for 11 physician characteristics (including health care quality at baseline).

Results: Nearly half (43%) of the physicians were portal users. Non-users performed at or above the regional benchmark on 48% of the measures at baseline and 49% of the measures at follow-up (p = 0.58). Users performed at or above the regional benchmark on 57% of the measures at baseline and 64% at follow-up (p<0.001). Use of the portal was independently associated with higher quality of care at follow-up for those measures expected to be affected by the portal (p = 0.01), but not for those not expected to be affected by the portal (p = 0.12).

Conclusions: Use of an electronic portal for viewing clinical data was associated with modest improvements in ambulatory quality.


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Keywords

Health care quality - clinical informatics - quality indicators

 


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Conflicts of interest

The authors have no conflicts of interest to disclose.

  • References

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    PubMed
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    PubMedGoogle Scholar
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    CrossrefPubMedGoogle Scholar
  • 10 Fontaine P, Ross SE, Zink T, Schilling LM. Systematic review of health information exchange in primary care practices. J Am Board Fam Med 2010; 23: 655-670.
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    Article in Thieme ConnectPubMedGoogle Scholar
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    CrossrefPubMedGoogle Scholar
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    CrossrefPubMedGoogle Scholar
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    CrossrefPubMedGoogle Scholar
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    CrossrefPubMedGoogle Scholar
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    CrossrefPubMedGoogle Scholar
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    CrossrefPubMedGoogle Scholar
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    CrossrefPubMedGoogle Scholar
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  • 21 Vest JR. Health information exchange and healthcare utilization. J Med Syst 2009; 33: 223-231.
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    PubMed
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    PubMedGoogle Scholar
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    PubMedGoogle Scholar
  • 29 Hincapie AL, Warholak TL, Murcko AC, Slack M, Malone DC. Physicians’ opinions of a health information exchange. J Am Med Inform Assoc 2011; 18: 60-65.
    CrossrefPubMedGoogle Scholar
  • 30 Patel V, Abramson EL, Edwards A, Malhotra S, Kaushal R. Physicians’ potential use and preferences related to health information exchange. Int J Med Inform 2011; 80: 171-180.
    CrossrefPubMedGoogle Scholar
  • 31 O’Donnell HC, Patel V, Kern LM, Barron Y, Teixeira P, Dhopeshwarkar R. et al. Healthcare consumers’ attitudes towards physician and personal use of health information exchange. J Gen Intern Med 2011; 26: 1019-1026.
    CrossrefPubMedGoogle Scholar
  • 32 Patel VN, Dhopeshwarkar RV, Edwards A, Barron Y, Likourezos A, Burd L. et al. Low-income, ethnically diverse consumers’ perspective on health information exchange and personal health records. Inform Health Soc Care 2011; 36: 233-252.
    CrossrefPubMedGoogle Scholar
  • 33 Patel VN, Dhopeshwarkar RV, Edwards A, Barron Y, Sparenborg J, Kaushal R. Consumer Support for Health Information Exchange and Personal Health Records: A Regional Health Information Organization Survey. J Med Syst. 2010 (epub ahead of print).
    PubMedGoogle Scholar
  • 34 Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The value of health care information exchange and interoperability. Health Aff (Millwood) 2005; Suppl. Web Exclusives: W5-8.
    PubMedGoogle Scholar
  • 35 DesRoches CM, Campbell EG, Rao SR, Donelan K, Ferris TG, Jha A. et al. Electronic health records in ambulatory care –a national survey of physicians. N Engl J Med 2008; 359: 50-60.
    CrossrefPubMedGoogle Scholar
  • 36 Byrne CM, Mercincavage LM, Pan EC, Vincent AG, Johnston DS, Middleton B. The value from investments in health information technology at the U. S. Department of Veterans Affairs. Health Aff (Millwood) 2010; 29: 629-638.
    CrossrefPubMedGoogle Scholar
  • 37 Chen C, Garrido T, Chock D, Okawa G, Liang L. The Kaiser Permanente Electronic Health Record: transforming and streamlining modalities of care. Health Aff (Millwood) 2009; 28: 323-333.
    CrossrefPubMedGoogle Scholar
  • 38 Paulus RA, Davis K, Steele GD. Continuous innovation in health care: implications of the Geisinger experience. Health Aff (Millwood) 2008; 27: 1235-1245.
    CrossrefPubMedGoogle Scholar
  • 39 McCormick D, Bor DH, Woolhandler S, Himmelstein DU. Giving office-based physicians electronic access to patients’ prior imaging and lab results did not deter ordering of tests. Health Aff (Millwood) 2012; 31: 488-496.
    CrossrefPubMedGoogle Scholar
  • 40 U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology.. HITECH Programs. (Accessed April 11, 2012.) Available from: http://healthit.hhs.gov/ portal/server.pt/community/healthit_hhs_gov_hitech_programs/1487.
    PubMed
  • 41 U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology.. Nationwide Health Information Network: Overview. (Accessed April 11, 2012.) Available from: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov_nationwide_health_information_network/1142
    PubMed

Correspondence to:

Lisa M. Kern, MD, MPH
Center for Healthcare Informatics and Policy
Weill Cornell Medical College
425 East 61st Street, New York, NY 10065
Phone: 646–962–9402   
Fax: 646–962–0105   

  • References

  • 1 American Recovery and Reinvestment Act of 2009, Pub L No. 111–5, 123 Stat 115 (2009).
    PubMed
  • 2 Steinbrook R. Health care and the American Recovery and Reinvestment Act. N Engl J Med 2009; 360: 1057-1060.
    CrossrefPubMedGoogle Scholar
  • 3 Kern LM, Dhopeshwarkar R, Barron Y, Wilcox A, Pincus H, Kaushal R. Measuring the effects of health information technology on quality of care: a novel set of proposed metrics for electronic quality reporting. Jt Comm J Qual Patient Saf 2009; 35: 359-369.
    PubMedGoogle Scholar
  • 4 Smith PC, Araya-Guerra R, Bublitz C, Parnes B, Dickinson LM, Van Vorst R. et al. Missing clinical information during primary care visits. JAMA 2005; 293: 565-571.
    CrossrefPubMedGoogle Scholar
  • 5 Blumenthal D, Glaser JP. Information technology comes to medicine. N Engl J Med 2007; 356: 2527-2534.
    CrossrefPubMedGoogle Scholar
  • 6 Halamka JD. Health information technology: shall we wait for the evidence?. Ann Intern Med 2006; 144: 775-776.
    CrossrefPubMedGoogle Scholar
  • 7 Kaelber DC, Bates DW. Health information exchange and patient safety. J Biomed Inform 2007; 40: S40.
    CrossrefPubMedGoogle Scholar
  • 8 Institute of Medicine.. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D. C.: National Academy Press,; 2001
    Google Scholar
  • 9 Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E. et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006; 144: 742-752.
    CrossrefPubMedGoogle Scholar
  • 10 Fontaine P, Ross SE, Zink T, Schilling LM. Systematic review of health information exchange in primary care practices. J Am Board Fam Med 2010; 23: 655-670.
    CrossrefPubMedGoogle Scholar
  • 11 Hincapie A, Warholak T. The impact of health information exchange on health outcomes. Applied Clinical Informatics 2011; 2: 499-507.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Bates DW, Kuperman GJ, Rittenberg E, Teich JM, Fiskio J, Ma’luf N. et al. A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests. Am J Med 1999; 106: 144-150.
    CrossrefPubMedGoogle Scholar
  • 13 Kuperman GJ, Teich JM, Tanasijevic MJ, Ma’Luf N, Rittenberg E, Jha A. et al. Improving response to critical laboratory results with automation: results of a randomized controlled trial. J Am Med Inform Assoc 1999; 6: 512-522.
    CrossrefPubMedGoogle Scholar
  • 14 Stair TO. Reduction of redundant laboratory orders by access to computerized patient records. J Emerg Med 1998; 16: 895-897.
    CrossrefPubMedGoogle Scholar
  • 15 Tierney WM, McDonald CJ, Martin DK, Rogers MP. Computerized display of past test results. Effect on outpatient testing. Ann Intern Med 1987; 107: 569-574.
    CrossrefPubMedGoogle Scholar
  • 16 Matheny ME, Gandhi TK, Orav EJ, Ladak-Merchant Z, Bates DW, Kuperman GJ. et al. Impact of an automated test results management system on patients’ satisfaction about test result communication. Arch Intern Med 2007; 167: 2233-2239.
    CrossrefPubMedGoogle Scholar
  • 17 Nguyen TQ, Thorpe L, Makki HA, Mostashari F. Benefits and barriers to electronic laboratory results reporting for notifiable diseases: the New York City Department of Health and Mental Hygiene experience. Am J Public Health 2007; 97 (Suppl. 01) S142-S145.
    CrossrefPubMedGoogle Scholar
  • 18 Overhage JM, Grannis S, McDonald CJ. A comparison of the completeness and timeliness of automated electronic laboratory reporting and spontaneous reporting of notifiable conditions. Am J Public Health 2008; 98: 344-350.
    CrossrefPubMedGoogle Scholar
  • 19 Frisse ME, Johnson KB, Nian H, Davison CL, Gadd CS, Unertl KM. et al. The financial impact of health information exchange on emergency department care. J Am Med Inform Assoc. 2011 (epub ahead of print).
    PubMedGoogle Scholar
  • 20 Hansagi H, Olsson M, Hussain A, Ohlen G. Is information sharing between the emergency department and primary care useful to the care of frequent emergency department users?. Eur J Emerg Med 2008; 15: 34-39.
    CrossrefPubMedGoogle Scholar
  • 21 Vest JR. Health information exchange and healthcare utilization. J Med Syst 2009; 33: 223-231.
    CrossrefPubMedGoogle Scholar
  • 22 Kern LM, Barron Y, Blair AJ, 3rd Salkowe J, Chambers D, Callahan MA. et al. Electronic result viewing and quality of care in small group practices. J Gen Intern Med 2008; 23: 405-410.
    CrossrefPubMedGoogle Scholar
  • 23 Taconic IPA. (Accessed April 11, 2012.) Available from: www.taconicipa.com.
    PubMed
  • 24 MVP Health Care.. (Accessed April 11, 2012.) Available from: www.mvphealthcare.com.
    PubMed
  • 25 Stuard SS, Blair AJ. Interval examination: regional transformation of care delivery in the hudson valley. J Gen Intern Med 2011; 26: 1371-1373.
    CrossrefPubMedGoogle Scholar
  • 26 MedAllies.. (Accessed April 11, 2012.) Available from: www.medallies.com.
    PubMed
  • 27 Verisk Health.. Sightlines DxCG Risk Solutions. (Accessed April 11, 2012.) Available from: www.verisk health.com.
    PubMedGoogle Scholar
  • 28 Ash AS, Ellis RP, Pope GC, Ayanian JZ, Bates DW, Burstin H. et al. Using diagnoses to describe populations and predict costs. Health Care Financ Rev 2000; 21: 7-28.
    PubMedGoogle Scholar
  • 29 Hincapie AL, Warholak TL, Murcko AC, Slack M, Malone DC. Physicians’ opinions of a health information exchange. J Am Med Inform Assoc 2011; 18: 60-65.
    CrossrefPubMedGoogle Scholar
  • 30 Patel V, Abramson EL, Edwards A, Malhotra S, Kaushal R. Physicians’ potential use and preferences related to health information exchange. Int J Med Inform 2011; 80: 171-180.
    CrossrefPubMedGoogle Scholar
  • 31 O’Donnell HC, Patel V, Kern LM, Barron Y, Teixeira P, Dhopeshwarkar R. et al. Healthcare consumers’ attitudes towards physician and personal use of health information exchange. J Gen Intern Med 2011; 26: 1019-1026.
    CrossrefPubMedGoogle Scholar
  • 32 Patel VN, Dhopeshwarkar RV, Edwards A, Barron Y, Likourezos A, Burd L. et al. Low-income, ethnically diverse consumers’ perspective on health information exchange and personal health records. Inform Health Soc Care 2011; 36: 233-252.
    CrossrefPubMedGoogle Scholar
  • 33 Patel VN, Dhopeshwarkar RV, Edwards A, Barron Y, Sparenborg J, Kaushal R. Consumer Support for Health Information Exchange and Personal Health Records: A Regional Health Information Organization Survey. J Med Syst. 2010 (epub ahead of print).
    PubMedGoogle Scholar
  • 34 Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The value of health care information exchange and interoperability. Health Aff (Millwood) 2005; Suppl. Web Exclusives: W5-8.
    PubMedGoogle Scholar
  • 35 DesRoches CM, Campbell EG, Rao SR, Donelan K, Ferris TG, Jha A. et al. Electronic health records in ambulatory care –a national survey of physicians. N Engl J Med 2008; 359: 50-60.
    CrossrefPubMedGoogle Scholar
  • 36 Byrne CM, Mercincavage LM, Pan EC, Vincent AG, Johnston DS, Middleton B. The value from investments in health information technology at the U. S. Department of Veterans Affairs. Health Aff (Millwood) 2010; 29: 629-638.
    CrossrefPubMedGoogle Scholar
  • 37 Chen C, Garrido T, Chock D, Okawa G, Liang L. The Kaiser Permanente Electronic Health Record: transforming and streamlining modalities of care. Health Aff (Millwood) 2009; 28: 323-333.
    CrossrefPubMedGoogle Scholar
  • 38 Paulus RA, Davis K, Steele GD. Continuous innovation in health care: implications of the Geisinger experience. Health Aff (Millwood) 2008; 27: 1235-1245.
    CrossrefPubMedGoogle Scholar
  • 39 McCormick D, Bor DH, Woolhandler S, Himmelstein DU. Giving office-based physicians electronic access to patients’ prior imaging and lab results did not deter ordering of tests. Health Aff (Millwood) 2012; 31: 488-496.
    CrossrefPubMedGoogle Scholar
  • 40 U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology.. HITECH Programs. (Accessed April 11, 2012.) Available from: http://healthit.hhs.gov/ portal/server.pt/community/healthit_hhs_gov_hitech_programs/1487.
    PubMed
  • 41 U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology.. Nationwide Health Information Network: Overview. (Accessed April 11, 2012.) Available from: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov_nationwide_health_information_network/1142
    PubMed

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